Physiotherapy Rehabilitation helps patients with Traumatic Brain Injury

Brain injury is the leading cause of injury death and disability in young adults following an accident. TBI or traumatic brain injury can manifest in a variety of clinical symptoms, which makes treating such patients extremely challenging. Physiotherapists play an important role in providing care services to such patients and the different methods of treatment help improve the patient’s functional status. They work with patients with traumatic brain injury in acute inpatient, followed by home-based phases of rehabilitation.

The Consequences of TBI

TBI can have numerous and complex neurological consequences which require extensive and specific rehabilitation of the affected person. Studies suggest that early and intensive rehabilitation has a number of positive effects on patients with TBI. In the initial and more acute phase, physiotherapists focus on respiratory care, passive range of motion treatment as well as helping patients reduce spasticity. In the later phases, the treatment mostly consists of the use of different approaches, such as functional training and training of compensator strategies.

Rehabilitation Phases for TBI

The first step of the rehabilitation process requires physiotherapists to identify any physical impairments which are directly related to the brain injury. They also have to identify impairments that are secondary to concomitant orthopedic or spinal cord injury. Identifying the physical impairments helps give them an idea about the patient’s needs and capacity for progress in the rehabilitation phase. The professional will then coordinate the rehabilitation therapy and will observe the outcome.

Several specific physiotherapeutic methods are known to show positive effects in patients with TBI.

These methods include:

• Mobilization
• Sensory stimulation
• Fitness or aerobic training
• Respiratory therapy
• Functional training
• Contracture prophylaxis

Patients are made to go through arm and gait ability training as well as sit-to-stand training. Different treatment methods are used by physiotherapists based on the patient’s problems. Patients are regularly assessed during rehabilitation to determine whether the goals set at the beginning of treatment were achieved.

Goals for TBI Therapy Treatment

Throughout the rehabilitation phase, the goal of the physiotherapist is to stabilize the medical and rehabilitation issues related to brain injury as well as other injuries. The physiotherapist also has to prevent secondary complications from developing such as pressure sores, contractures, and pneumonia. Physiotherapists also work with the patient to restore functional abilities which may be limited as a result of their injuries. These abilities include simple day-to-day tasks such as eating, drinking, talking, moving around, using the bathroom, and even thinking. Certain adaptive devices of strategies are used by the staff in order to enhance functional independence in TBI patients. The patient is analyzed to determine if any special requirements need to be met once the person goes home. The family of the patient is also involved at all times so they understand the needs of the patient.

Patients participating in therapy need assistance all the time even with the most simple activities such as getting out of bed, brushing teeth, eating and drinking. Staff also ensures the safety of the patient as they have a risk of falling and getting hurt. Oftentimes, patients may be confused and forgetful. Physiotherapist and Rehabilitation nurses assist patients with brain injury and chronic illness to attain maximum optimal health by adapting to an altered lifestyle.

Sports are a fun and healthy form of both recreation and physical fitness for adults and children alike. However, with all of the benefits of sports also comes the risk of serious injuries. Athletes, especially those who play sports for a living, suffer from various injuries on a regular basis, such as broken bones, fractures and strains. One common type of sports injury that can significantly impact all aspects of the athlete’s life is a traumatic brain injury (TBI).

What Is TBI?

A traumatic brain injury is defined as damage to part of the brain caused by an extreme or serious mechanical force that results in brain dysfunction. In most cases, especially those involving a mild TBI, the signs and symptoms of the medical condition may not immediately surface, making the condition less likely to be diagnosed soon after the accident.

If you or a loved one has been involved in any type of accident that involved a blow or jolt to the head and have experienced any of the following signs or symptoms, you should seek immediate medical attention:

• Unusual headaches
• Dizziness or disorientation
• Seizure or convulsions
• Nausea or vomiting
• Confusion or disorientation
• Balance and coordination issues
• Agitation
• Memory loss
• Challenges in oral and/or written communication
• Difficulty concentrating and/or following directions
• Slurred speech
• Depression

The severity of a traumatic brain injury can range from a mild concussion to a severe trauma that results in permanent and life altering disabilities. As such, if you believe that you or a loved one has suffered a TBI, it is important that you seek immediate medical care and get properly diagnosed, treated and monitored.

The TBI Statistics

According to the Centers for Disease Control and Prevention (CDC), approximately 2.5 million emergency department visits, hospitalizations or deaths are associated with TBI each year in the United States. In 2009, an estimated 248,418 young adults were treated in emergency rooms for sports related injuries that included a diagnosis of a concussion or TBI. Unfortunately, thousands of other sports related TBI cases go unreported each year.

In sports, common types of forces that may result in a traumatic brain injury include:

• Getting hit by an object, such as a bat or a ball
• Physical contact with another player
• Hitting your head on the ground, pole or any other object
• Getting jolted so your brain shakes inside your skull

The majority of sports related TBIs care caused by not having appropriate safety equipment, failing to medically asses athletes on the field, allowing athletes to return to play after a TBI, and encouraging physical contact and rough play on the field.

Call a New York Car Accident Attorney Today

If you or a loved one has suffered a sports-related traumatic brain injury, you may have a valid personal injury claim and be entitled to monetary compensation. For more information or to consult with one of our experienced New York sports-related TBI attorneys, please call Gersowitz Libo & Korek, P.C. at 1-800-529-9997.

In the May 25, 2010 issue of Neurology, Australian physician J.A. Shekleton, M.D., and colleagues published an article regarding their study of the sleep patterns of people with severe TBI. The researchers had 23 people who had sustained a severe TBI an average of 14 months earlier and 23 age-matched, healthy people spend two nights in a sleep lab.

The TBI group took more time to fall asleep (an average of 62 minutes vs. 27 minutes for the control group), spent less time in bed actually sleeping, and spent more time in non-REM sleep (also called dreamless, slow-wave-sleep). The researchers found that people in the TBI group produced less melatonin in the evening hours than people in the control group. Melatonin is a hormone produced by the pineal gland in the brain which is supposed to increase at night (in concert with growing darkness) to signal the body to go to sleep.

Progesterone is a naturally occurring hormone found in both genders. The brain is loaded with progesterone receptors. Dr. David Wright, associate professor of emergency medicine at Emory University School of Medicine, is an expert on using progesterone in the emergency room to treat new cases of TBI. In an earlier 3 year trial on 100 patients he demonstrated that emergency treatment with progesterone reduced mortality by 50% in cases of severe TBI while improving functional outcome and reducing disability in people with moderate TBI.

Now the National Institute of Health has funded a grant to Emory University to conduct phase III clinical trials of progesterone on patients with TBI at 17 medical centers across the country. The study will enroll approximately 1,140 patients over a 3-6 year period beginning in March 2010. Dr. Wright will lead the study and Atlanta’s Grady Memorial Hospital will serve as the lead medical center with faculty from Emory School of Medicine and Morehouse School of Medicine. Dr. Wright said that no new treatment for severe TBI had been approved in the past 30 years and he is very excited about the promise of progesterone as a new treatment pending the outcome of the new study.

At this time there is no FDA approved treatment for TBI. Experiments have been done with cooling helmets and hyperbaric oxygen chambers, but these have not led to FDA approval. Physicians keep trying. Recently scientists as the Salk Institute for Biological Study observed that a compound called CNB-001 (the active ingredient in the curry spice tumeric) effectively protected brain cells in animals from damage consequent to ischemic stroke and TBI.

In collaboration with researchers at Cedars-Sinai and UCLA the Salk Institute scientists tested a synthetic derivative of this compound. They found that after inducing ischemic stroke or TBI in animals, and giving them the synthetic tumeric compound, the animals’ behavior was relatively normal. During autopsy they found the brain cells in these animals had been spared much of the damage which normally flows from ischemic stroke and TBI. The compound does not work by dissolving blood clots (like the drug TPA for strokes). Rather it has a direct neuro-protective effect on traumatized brain cells. The study was published in the December 2, 2010 issue of the Journal of Neurochemistry. Research on the compound is still a far way off from any human trials.

Some physicians prescribe stimulant containing amphetamines like Dexedrine for people with TBI to increase their wakefulness, energy, and attentional focus. While these are all good benefits, there is a cost to chronic amphetamine use beyond addiction. According to a study released on February 22, 2011 by Stephen K. Van Den Eeden, PhD of Kaiser Permanente of Northern California, the chronic use of amphetamines increases the risk of developing Parkinson’s disease by 60%.

The study was based on analysis of the health records of 66,348 Kaiser patients between 1964 and 1973 who were evaluated again in 1995. The participants’ average age at the start of the study was 36. In the 1960s it was common to use amphetamines for weight loss. The people in the study who used amphetamines regularly showed a 60% increased risk of developing Parkinson’s. Long term use of amphetamine interferes with the release and absorption of dopamine in the human brain. Hence TBI patients asked to take amphetamines by their physician should weigh this risk with their family and their physician.

A University of Colorado Boulder study published in the January 2011 issue of the Journal of Neurotrauma indicates that Jin Shin acupressure treatment (in which fingertip pressure is applied to instead of acupuncture needles) can improve cognitive function in people with mild TBI. The mild TBI group treated by an expert with acupressure to 26 points on the body from head to toe showed improved attention and working memory on neuropsychological testing. The placebo group which was treated by a non-expert with acupressure to random points on the body showed no cognitive improvement. The treated group also showed more rapid brain activity in response to testing than the placebo group.

Funded by the Colorado Traumatic Brain Injury Trust Fund, the study is believed to be one of the first placebo-controlled studies ever published in a peer-reviewed medical journal showing the benefit of acupressure to treat patients with TBI, Hernandez said. The Jin Shin acupressure treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, which could allow for more independence said lead study author Theresa Hernandez, Ph.D.

In March 2011 researchers in Glasgow, Scotland, reported in the Journal of Neurology Neurosurgery and Psychiatry that people with a of death for 13 years following their injury. They tracked 2,000 people (757 of whom had a Traumatic Brain Injury) who were admitted to one of five Glasgow hospitals between 1995-1996. They designated three groups to compare: the 757 admitted to the hospital for a TBI; 1,243 admitted for other reasons; and a third group of healthy people living in the community. All three groups were matched for age, gender, and socio-economic status.

In all, 40% of people (305) who had sustained a TBI of any severity were dead within 13 years of the event. This was higher than the rate among those admitted with other injuries (28%) and those in the community, almost one in five of whom died (19%). Although the heightened risk of death was highest in the first year after injury, it persisted for at least a further 12 years, when the head-injured were almost three times as likely to die of circulatory, respiratory, digestive, psychiatric and external causes as their community peers. As might be expected, those with more serious injuries were more likely to die than those with mild injuries during the critical first year. But those with mild head injury were also twice as likely to die.

More than a year later, the young and middle aged were far more likely to die than those who were older, when compared with those with no head injury. Deaths among those aged 15 to 54 were more than six times higher than rates among those without a head injury, irrespective of potentially influential factors, such as gender and level of deprivation. The researchers said, “The reason for greater vulnerability in younger adults is unclear, but requires further consideration, especially given the particularly higher risk of head injury in younger adults.”